title: Outcome of elective endovascular abdominal aortic aneurysm repair in nonagenarians.
abstract: OBJECTIVE
  Compared with open repair of abdominal aortic aneurysms (AAA), endovascular repair (EVAR) is associated with decreased perioperative morbidity and mortality in a standard patient population. This study sought to determine if the advantage of EVAR extends to patients aged ≥90 years.
  
  
  METHODS
  This was a retrospective review from a prospectively maintained computerized database. Of the 322 patients aged ≥80 treated with EVAR from January 1997 to November 2007, 24 (1.9%) were aged ≥90. Mean age was 91.5 ± 1.5 years (range, 90-95 years), and 83.3% were men. Mean aneurysm size was 6.8 cm (range, 5.2-8.7 cm).
  
  
  RESULTS
  Mean procedural blood loss was 490 mL (range, 100-4150 mL), and 20.8% required an intraoperative transfusion. Mean postoperative length of stay was 6.0 days, (median, 4 days; mode, 1 day; range, 1-42 days), with 33.3% of patients discharged on the first postoperative day. Amongst the 24 patients, there were 6 (25.0%) perioperative major adverse events, and 2 patients died, for a perioperative mortality rate of 8.3%. Mean follow-up was 20.5 months (range, 1-49 months). Overall, three patients (12.5%) required a secondary intervention, comprising thrombectomy, angioplasty, and proximal cuff extension. No patients required conversion to open repair. Two patients (8.3%) died of AAA rupture at 507 and 1254 days. Freedom from all-cause mortality was 83.3% at 1 year and 19.3% at 5 years. Freedom from aneurysm-related mortality was 87.5% at 1 year and 73.2% at 5 years. Endoleak occurred in five patients (20.8%), with three type I and two of indeterminate type; of these, two patients with type I endoleak underwent secondary intervention at 153 and 489 days after EVAR, of which one case was successful.
  
  
  CONCLUSIONS
  Our study supports that EVAR in nonagenarians is associated with acceptable procedural success and perioperative morbidity and mortality. The medium-term results suggest that EVAR may be of limited benefit in very carefully selected patients who are aged ≥90 years.
authors.affiliation: Department of Surgery, Mount Sinai School of Medicine, New York, NY, USA.
authors.forename: Stuart B
authors.initials: SB
authors.lastname: Prenner
authors.forename: Irene C
authors.initials: IC
authors.lastname: Turnbull
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Serrao
authors.forename: Eric
authors.initials: E
authors.lastname: Fishman
authors.forename: Sharif H
authors.initials: SH
authors.lastname: Ellozy
authors.forename: Angeliki G
authors.initials: AG
authors.lastname: Vouyouka
authors.forename: Michael L
authors.initials: ML
authors.lastname: Marin
authors.forename: Peter L
authors.initials: PL
authors.lastname: Faries
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000209:etiology / Q000401:mortality; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D019992:Databases as Topic; D017558:Elective Surgical Procedures; D057867:Endoleak / Q000209:etiology / Q000628:therapy; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D009519:New York City; D018579:Patient Selection; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome